BREAst screening Tailored for HEr (BREATHE)—A study protocol on personalised risk-based breast cancer screening programme

Abstract

Routine mammography screening is currently the standard tool for finding cancers at an early stage, when treatment is most successful. Current breast screening programmes are one-size-fits-all which all women above a certain age threshold are encouraged to participate. However, breast cancer risk varies by individual. The BREAst screening Tailored for HEr (BREATHE) study aims to assess acceptability of a comprehensive risk-based personalised breast screening in Singapore. Advancing beyond the current age-based screening paradigm, BREATHE integrates both genetic and non-genetic breast cancer risk prediction tools to personalise screening recommendations. BREATHE is a cohort study targeting to recruit ~3,500 women. The first recruitment visit will include questionnaires and a buccal cheek swab. After receiving a tailored breast cancer risk report, participants will attend an in-person risk review, followed by a final session assessing the acceptability of our risk stratification programme. Risk prediction is based on: a) Gail model (non-genetic), b) mammographic density and recall, c) BOADICEA predictions (breast cancer predisposition genes), and d) breast cancer polygenic risk score. For national implementation of personalised risk-based breast screening, exploration of the acceptability within the target populace is critical, in addition to validated predication tools. To our knowledge, this is the first study to implement a comprehensive risk-based mammography screening programme in Asia. The BREATHE study will provide essential data for policy implementation which will transform the health system to deliver a better health and healthcare outcomes.

Polygenic risk scores for the prediction of common cancers in East Asians: A population-based prospective cohort study

“…The best-performing PRS for female breast cancer was able to stratify women into distinct bands of breast cancer risk at an earlier age, and across all ages, suggesting that it could be a useful prediction tool in risk-based breast cancer screening in combination with other risk factors specific to breast cancer [17]. This PRS has been incorporated into a pilot risk-based breast cancer screening study in a comparable study population [32]. The best performing PRS for prostate and male colorectal cancers in this study appeared to exhibit sufficient discriminatory ability and predictive value, especially for older participants.…”

Breast Cancer in Asia: Incidence, Mortality, Early Detection, Mammography Programs, and Risk-Based Screening Initiatives

“…BREAst screening Tailored for HEr (BREATHE) is a pilot stratified mammography screening study in Singapore [ 195 ]. The program integrates both non-genetic and genetic breast cancer risk prediction tools to personalize screening recommendations.…”

“…The program integrates both non-genetic and genetic breast cancer risk prediction tools to personalize screening recommendations. Predictions are based on the following: (1) Gail model (non-genetic), (2) mammographic density and recall, (3) BOADICEA predictions (breast cancer predisposition genes), and (4) breast cancer polygenic risk score (PRS) [ 195 ]. The BREATHE’s risk classification decision tree is adapted from the established WISDOM Personalized Breast Cancer Screening Trial [ 188 ].…”

Breast Cancer in Asia: Incidence, Mortality, Early Detection, Mammography Programmes, and Risk-based Screening Initiatives

“…BREAst screening Tailored for HEr (BREATHE) is a pilot stratified mammography screening study in Singapore [171]. The program integrates both non-genetic and genetic breast cancer risk prediction tools to personalize screening recommendations.…”

“…The program integrates both non-genetic and genetic breast cancer risk prediction tools to personalize screening recommendations. Predictions are based on: 1) Gail model (non-genetic), 2) mammographic density and recall, 3) BOA-DICEA predictions (breast cancer predisposition genes), and 4) breast cancer polygenic risk score (PRS) [171]. The BREATHE's risk classification decision tree is adapted from the established WISDOM Personalized Breast Cancer Screening Trial [164].…”